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Personally I think a posterior repair via an open approach is a terrible idea. Logistically it makes sense. All the benefits of a posterior repair without any of the logistical problems that a company intra-abdominal surgery.
But in practice I don’t think that you can deploy a posterior mesh reliably and safely blindly.
There are a lot of sensitive structures back there. Potentially more contributing to bigger problems than nerve entrapment in an anterior approach.
But you still get that nerve entrapment risk from an anterior approach because that’s how you got there in the first place. Admittedly it may be less if you’re not deploying a mesh there.
You develop a space blindly and then lay mesh back there blindly and hope that it lays out properly without interfering with any sensitive structures, all of which are in the neighborhood.
When things go wrong it’s extremely difficult to remediate.
The advantage of a posterior approach for a posterior repair is you can see exactly what you are doing to minimize complications with sensitive structures back there.
Admittedly it has many drawbacks such as violating the peritoneum and adhesion risk.
TEP seems like a very attractive approach for a posterior repair for that reason.